A Randomized, Controlled, Behavioral Intervention to Promote Walking after Abdominal Organ Transplantation: Results from the LI

Kidney transplant recipients (KTRs) and liver transplant recipients (LTRs) have significant post-transplant weight gain and low physical activity. We conducted a home-based, remotely-monitored intervention using wearable accelerometer devices to promote post-transplant physical activity. We randomized 61 KTRs and 66 LTRs within 24 months of transplant to: 1) control, 2) accelerometer, or 3) intervention: accelerometer paired with financial incentives and health engagement questions to increase steps by 15% from baseline every 2 weeks. The primary outcome was weight change. A co-primary outcome for the two accelerometer arms was steps. Participants were recruited at a median of 9.5 [3-17] months post-transplant. At 3 months, there were no significant differences in weight change across the 3 arms. The intervention arm was more likely to achieve ≥7000 steps compared to control with device (OR 1.99, 95% CI:1.03-3.87); effect remained significant after adjusting for demographics, allograft, time from transplant, and baseline weight. Adherence to target step goals was 74% in the intervention arm, 84% of health engagement questions were answered correctly. A pilot study with financial incentives and health engagement questions was feasible and led KTRs and LTRs to walk more, but did not affect weight. A definitive trial is warranted. (ClinicalTrials.gov number: NCT03221465).